Appreciating Ling Yunpeng Case of Treating Postoperative Tissue Adhesion
The patient, a woman named Bao, 55, had her gallbladder surgically removed in May 1966 for gallstones, yet still suffered severe pain. A second exploratory surgery in April 1967 diagnosed postoperative tissue adhesion; afterward the pain recurred frequently, accompanied by vomiting. On November 4, 1972, she first sought out veteran doctor Ling Yunpeng, asking to take Chinese medicine to improve her symptoms.
Dr. Ling carefully asked about her symptoms. She said that during pain, the upper abdomen became hard and protruded, gradually easing after passing gas. Her pulse was string-like, and her tongue coating was white and greasy. Dr. Ling held that her cause was mainly rebellious, obstructed qi flow that over time led to qi stagnation and blood stasis, so he treated by descending qi and reducing distension, soothing the liver and regulating qi, and resolving stasis to stop pain. Prescription: Sugeng (Perilla Stem) 9g, Baishao (White Peony) 24g, Yanhusuo (Corydalis) 12g, Sheng Gancao (Raw Licorice) 9g, Qingpi (Tangerine Peel) 12g, Dafupi (Areca Peel) 12g, Chao Zhiqiao (Fried Immature Bitter Orange) 9g, Binglang (Areca) 6g, Gualou (Trichosanthes Fruit) 18g, Meiguihua (Rose) 2g. Ten doses, decocted in water.
The patient returned in April 1973, saying the pain had basically resolved after taking the medicine the previous year; it recurred once this spring, and she cured herself by taking three doses of the original formula. But it recurred again in April, and after two doses of the original formula she still felt distending pain, so she hoped Dr. Ling would adjust the formula.
Dr. Ling found her pulse still string-like and her tongue red with a thin greasy coating, so he added Houpo (Magnolia) 6g and Muxiang (Aucklandia) 9g to the previous formula and had her continue. A follow-up in 1977 found her symptoms had basically disappeared, with only occasional distending pain; when it flared, she took two or three doses of the formula on her own and recovered, and there had been no severe pain in recent years.
Postoperative tissue adhesion is a common surgical complication, and many patients have similar experiences; some even die from it. Western medicine has no good way for this, offering only antispasmodic painkillers during pain and occasionally a second surgery to relieve suffering. Some patients pain or discomfort (some feel numbness and coldness at the operative site) lasts for over ten years. Although this patient improved under Dr. Ling, her condition still dragged on for years; it merely stopped recurring as severely as before, showing how hard this disease is to treat.
Dr. Ling formula is a modified Baishao Gancao Tang (Peony-Licorice Decoction), which comes from the Shanghan Lun (Treatise on Cold Damage) and consists of Baishao (White Peony) and Gancao (Licorice). TCM holds it softens the liver and relieves pain—note that the TCM liver cannot be equated with the anatomical liver in Western medicine; TCM holds that most pain syndromes pertain to the liver, so the TCM liver also encompasses the nervous system of modern medicine. I often see patients look up a Chinese medicine, find it enters the Liver meridian, and anxiously assume some TCM doctor prescribed Liver-meridian herbs because their liver is diseased, showing how badly the conflation of TCM and modern-medicine concepts misleads patients.
In fact, Baishao Gancao Tang is an excellent antispasmodic painkiller. A few months ago, a liposarcoma patient developed spastic pain after chemotherapy; I merely suggested steeping 3g Baishao and 3g raw Gancao in boiling water for five minutes and drinking it as tea. In just a few days the pain stopped. Another patient in Shanghai had had leg cramps, unable to straighten, for five years after radiotherapy, making normal walking difficult; I told her to use the same method, and within a week her symptoms completely resolved and she walked freely.
So Baishao Gancao Tang is very effective for spastic pain. Professor Liu Duzhou once treated a patient with an unexplained tender lump in the groin; using the original Baishao Gancao Tang for only two or three days, the lump resolved. Dr. Ling chose this as the base formula, adding Sugeng, Qingpi, Chao Zhiqiao, and Dafupi to move qi, Meiguihua to soothe the liver and resolve depression, Yanhusuo to invigorate blood and stop pain, and Gualou to reduce swelling, dissipate nodules, and stop pain; he later added Houpo and Muxiang to strengthen qi-descending and qi-regulating, which solved this patient problem.
His approach inspires us: the pain from postoperative tissue adhesion is an iatrogenic disease caused by modern medicine and was rare in ancient times, so there is no ready-made formula to consult. But in disease mechanism, postoperative adhesion matches TCM qi stagnation and blood stasis; in treatment principle one may consider softening the liver and relieving pain plus invigorating blood and regulating qi. Once the principle is set, choosing formulas and herbs reasonably can also relieve the patient suffering.
Ordinary non-tumor patients with postoperative adhesion are relatively easier to treat; tumor patients with adhesion require considering whether residual tumor remains. Also, some adhesion patients may develop the complication of intestinal obstruction, for whom this approach cannot be copied. Obstruction patients given too many qi-regulating herbs have worse intestinal gas and more suffering.
I usually treat adhesion with intestinal obstruction by modifying Zengye Chengqi Tang combined with Baishao Gancao Tang (common formula: Xuanshen (Scrophularia) 30g, Maidong (Ophiopogon) 24g, Shengdi (Raw Rehmannia) 24g, Baishao (White Peony) 12g, Zhi Gancao (Honey-fried Licorice) 12g, Danggui (Angelica) 12g, Mangxiao (Mirabilite) 15-30g, Dahuang (Rhubarb) 6-30g), and do not lightly use qi-regulating herbs.